Abstract
This study examined the extent to which maternal attention-deficit/hyperactivity disorder (ADHD) symptoms predict improvement in child behavior following brief behavioral parent training. Change in parenting was examined as a potential mediator of the negative relationship between maternal ADHD symptoms and improvement in child behavior. Seventy mothers of 6–10 year old children with ADHD underwent a comprehensive assessment of adult ADHD prior to participating in an abbreviated parent training program. Before and after treatment, parenting was assessed via maternal reports and observations and child disruptive behavior was measured via maternal report. Controlling for pre-treatment levels, maternal ADHD symptomatology predicted post-treatment child disruptive behavior problems. The relation between maternal ADHD symptomatology and improvement in child behavior was mediated by change in observed maternal negative parenting. This study replicated findings linking maternal ADHD symptoms with attenuated child improvement following parent training, and is the first to demonstrate that negative parenting at least partially explains this relationship. Innovative approaches combining evidence-based treatment for adult ADHD with parent training may therefore be necessary for families in which both the mother and child have ADHD. Larger-scale studies using a full evidence-based parent training program are needed to replicate these findings.
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Abikoff, H., Abramowitz, A., Courtney, M., Cousins, L., Del Carmen, R., Eddy, M. et al. (1994). Parent training manual: MTA Study. Unpublished manual.
Ambrosini, P. J. (2000). Historical development and present status of the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS). Journal of the American Academy of Child and Adolescent Psychiatry, 39, 49–58.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
Aragona, J. A., & Eyberg, S. M. (1981). Neglected children: Mothers’ report of child behavior problems and observed verbal behavior. Child Development, 52, 596–602.
Axelrad, M., Garland, B., & Love, K. (2009). Brief behavioral intervention for young children with disruptive behaviors. Journal of Clinical Psychology in Medical Settings, 16, 263–269.
Barkley, R. (1997). Defiant children: A clinician’s manual for assessment and parent training (2nd ed.). New York: The Guilford Press.
Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: conceptual, strategic and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.
Biederman, J., Faraone, S. V., & Monuteaux, M. C. (2002). Impact of exposure to parental attention- deficit hyperactivity disorder on clinical features and dysfunction in the offspring. Psychological Medicine, 32, 817–827.
Campbell, J. M. (1998). Internal and external validity of seven Wechsler intelligence scale for children-third edition short forms in a sample of psychiatric inpatients. Psychological Assessment, 10, 431–434.
Chronis, A. M., Lahey, B. B., Pelham, W. E., Kipp, H. L., Baumann, B. L., & Lee, S. S. (2003). Psychopathology and substance abuse in parents of young children with attention deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 1424–1432.
Chronis, A. M., Chacko, A., Fabiano, G., Wymbs, B., & Pelham, W. (2004). Enhancements to the behavioral parent training paradigm for families of children with ADHD: review and future directions. Clinical Child and Family Psychology Review, 7, 1–27.
Chronis, A. M., Lahey, B. B., Pelham, W. E., Williams, S. H., Baumann, B. L., Kipp, H., et al. (2007). Maternal depression and early positive parenting predict future conduct problems in young children with attention-deficit/hyperactivity disorder. Developmental Psychology, 43, 70–82.
Chronis-Tuscano, A., Raggi, V. L., Clarke, T. L., Rooney, M. E., Diaz, Y., & Pian, J. (2008). Associations between maternal attention-deficit/hyperactivity disorder symptoms & parenting. Journal of Abnormal Child Psychology, 36, 1237–1250.
Chronis-Tuscano, A., Rooney, M., Seymour, K., Lavin, H., Pian, J., Robb, A., et al. (2010). Effects of maternal stimulant medication on observed parenting in mother-child dyads with attention- deficit/hyperactivity disorder. Journal of Clinical Child and Adolescent Psychology, 39, 581–587.
Conners, C., Erhardt, D., Epstein, J., Parker, J., Sitarenios, G., & Sparrow, E. (1999). Self-ratings of ADHD symptoms in adults: I. Factor structure and normative data. Journal of Attention Disorders, 3, 141–151.
Danforth, J., Barkley, R., & Stokes, T. (1991). Observations of parent-child interactions with hyperactive children: research and clinical implications. Clinical Psychology Review, 11, 703–727.
Erhardt, D., Epstein, J., Conners, C., Parker, J., & Sitarenios, G. (1999). Self-ratings of ADHD symptoms in adults: II. Reliability, validity, and diagnostic sensitivity. Journal of Attention Disorders, 3, 153–158.
Eyberg, S. M., & Matarazzo, R. G. (1981). Training parents as therapists: a comparison between individual parent-child interaction training and parent group didactic training. Journal of Clinical Psychology, 36, 492–499.
Eyberg, S. M., Funderburk, B. W., Hernbree-Kigin, T. L., McNeil, C. B., Querido, J. G., & Hood, K. K. (2001). Parent-child interaction therapy with behavior problem children: one and two year maintenance of treatment effects in the family. Child and Family Behavior Therapy, 23, 1–20.
Eyberg, S. M., Nelson, M. M., Duke, M., & Boggs, S. R. (2009). Manual for the Dyadic Parent-Child Interaction Coding System (DPICS), Third Edition. Available online at www.pcit.org.
Fabiano, G. (2007). Father participation in behavioral parent training for ADHD: review and recommendations for increasing inclusion and engagement. Journal of Family Psychology, 21, 683–693.
Fabiano, G. A., Pelham, W. E., Waschbusch, D. D., Gnagy, E. M., Lahey, B. B., Chronis, A. M., et al. (2006). A practical impairment measure: psychometric properties of the impairment rating scale in samples of children with attention-deficit/hyperactivity disorder and two school-based samples. Journal of Child and Adolescent Psychology, 35, 369–385.
Faraone, S. V., Biederman, J., Chen, W. J., Milberger, S., Warburton, R., & Tsuang, M. T. (1995). Genetic heterogeneity in attention-deficit hyperactivity disorder (ADHD): gender, psychiatric comorbidity, and maternal ADHD. Journal of Abnormal Psychology, 104, 334–345.
Faraone, S. V., Biederman, J., Feighner, J. A., & Monuteaux, M. C. (2000). Assessing symptoms of attention deficit hyperactivity disorder in children and adults: which is more valid? Journal of Consulting and Clinical Psychology, 68, 830–842.
Faraone, S. V., Perlis, R. H., Doyle, A. E., Smoller, J. W., Goralnick, J. J., Holmgren, M. A., et al. (2005). Molecular genetics of attention deficit/hyperactivity disorder. Biological Psychiatry, 57, 1313–1323.
First, M. B., Gibbon, M., Spitzer, R. L., & Williams, J. B. (1996). Structured clinical interview for DSM-IV axis I disorders. New York: Biometrics Research.
Furstenberg, F. (1988). Good dads-bad dads: Two faces of fatherhood. In M. Burt, W. Gorham, & S. B. Hitchner Jr. (Eds.), The changing American family and public policy (pp. 193–218). Washington, DC: Urban Institute Press.
Graham, J. W. (2009). Missing data analysis: making it work in the real world. Annual Review of Psychology, 60, 549–576.
Hinshaw, S., Owens, E., Wells, K., Kraemer, H., Abikoff, H., Arnold, L., et al. (2000). Family processes and treatment outcome in the MTA: negative/ineffective parenting practices in relation to multimodal treatment. Journal of Abnormal Child Psychology, 28, 555–568.
Johnston, C., & Mash, E. J. (2001). Families of children with attention deficit hyperactivity disorder: review and recommendations for future research. Clinical Child and Family Psychology Review, 4, 183–207.
Kenny, D. A. (2009). What is mediation? Retrieved September 2010, from http://davidakenny.net/cm/mediate.htm.
MacKinnon, D. P., Lockwood, C. M., Hoffman, J. M., West, S. G., & Sheets, V. (2002). A comparison of methods to test mediation and other intervening variable effects. Psychological Methods, 7, 83–104.
McBride, B. A., & Mills, G. (1993). A comparison of mother and father involvement with their preschool age children. Early Childhood Research Quarterly, 8, 457–477.
McGough, J. J., & Barkley, R. A. (2004). Diagnostic controversies in adult attention deficit hyperactivity disorder. The American Journal of Psychiatry, 161, 1948–1956.
McMahon, R. J., & Forehand, R. L. (2003). Helping the noncompliant child: Family-based treatment for oppositional behaviour (2nd ed.). New York: The Guilford Press.
McMahon, R. J., Munson, J. A., & Spieker, S. J. (1997, November). The Alabama parenting questionnaire: Reliability and validity in a high-risk longitudinal sample. Presentation at the Association for the Advancement of Behavior Therapy, Miama, Florida.
Miller, G. E., & Prinz, R. J. (1990). Enhancement of social learning family interventions for childhood conduct disorder. Psychological Bulletin, 108, 291–307.
Murray, C., & Johnston, C. (2006). Parenting in mothers with and without attention deficit/hyperactivity disorder. Journal of Abnormal Psychology, 115, 52–61.
Nixon, R., Sweeney, L., Erickson, D., & Touyz, S. (2003). Parent-child interaction therapy: a comparison of standard and abbreviated treatments for oppositional defiant preschoolers. Journal of Consulting and Clinical Psychology, 71, 251–260.
Orvaschel, H., & Puig-Antich, J. (1995). Schedule for affective disorders and schizophrenia for school- aged children-epidemiologic 5th version. Ft. Lauderdale: Nova University.
Parke, R. D. (1995). Fathers and families. In M. H. Bornstein (Ed.), Handbook of parenting (Vol. 3, pp. 27–73). Mahwah: Lawrence Erlbaum Associates.
Patterson, G. R. (1974). Interventions with boys with conduct problems: Multiple settings, treatments, and criteria. Journal of Consulting and Clinical Psychology, 42, 471–481.
Pelham, W. E., & Fabiano, G. (2008). Evidence-based psychosocial treatments for attention-deficit/hyperactivity disorder. Journal of Clinical Child and Adolescent Psychology, 37, 184–214.
Pelham, W. E., Gnagy, E. M., Greenslade, K. E., & Milch, R. (1992). Teacher ratings of DSM-III-R symptoms of the disruptive behavior disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 210–218.
Pelham, W. E., Wheeler, T., & Chronis, A. (1998). Empirically supported psychosocial treatments for attention-deficit hyperactivity disorder. Journal of Clinical Child and Adolescent Psychology, 27, 190–205.
Piacentini, J., Cohen, P., & Cohen, J. (1992). Combining discrepant diagnostic information from multiple sources: are complex algorithms better than simple ones? Journal of Abnormal Child Psychology, 20, 51–63.
Psychogiou, L., Daley, D., Thompson, M., & Sonuga-Barke, E. (2007). Testing the interactive effect of parent and child ADHD on parenting in mothers and fathers: a further test of the similarity-fit hypothesis. British Journal of Developmental Psychology, 25, 419–433.
Psychogiou, L., Daley, D. M., Thompson, M. J., & Sonuga-Bake, E. (2008). Do maternal attention-deficit/hyperactivity disorder symptoms exacerbate or ameliorate the negative effect of child attention-deficit/hyperactivity disorder symptoms on parenting? Development and Psychopathology, 20, 121–137.
Robinson, E. A., & Eyberg, S. M. (1981). The dyadic parent-child interaction coding system: standardization and validation. Journal of Consulting and Clinical Psychology, 49, 245–250.
Seguin, J. R., Nagin, D., Assaad, J., & Tremblay, R. (2004). Cognitive-neuropsychological function in chronic physical aggression and hyperactivity. Journal of Abnormal Psychology, 113, 603–613.
Shelton, K. K., Frick, P. J., & Wooton, J. (1996). Assessment of parenting practices in families of elementary school-age children. Journal of Clinical Child Psychology, 25, 317–329.
Sobel, M. E. (1982). Asymptotic confidence intervals for indirect effects in structural equation models. In S. Leinhardt (Ed.), Sociological methodology 1982. Washington, D.C.: American Sociological Association.
Sonuga-Barke, E. J., Daley, D., & Thompson, M. (2002). Does maternal ADHD reduce the effectiveness of parent training for preschool children’s ADHD? Journal of the American Academy of Child and Adolescent Psychiatry, 41, 696–702.
Todd, R. D., Sitdhiraksa, N., Reich, W., Ji, T., Joyner, C. A., Heath, A. C., et al. (2002). Discrimination of DSM-IV and latent class attention-deficit/hyperactivity disorder subtypes by educational and cognitive performance in a population-based sample of child and adolescent twins. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 820–828.
University of Washington Parenting Clinic (2000). Revised version of the Dyadic Parent-Child Interaction Coding System by S. Eyberg and E.A. Robinson. Available on-line at www.incredibleyears.com.
Webster-Stratton, C. (1998). Preventing conduct problems in head start children: strengthening parenting competencies. Journal of Consulting and Clinical Psychology, 66, 715–730.
Webster-Stratton, C., & Spitzer, A. (1992). Development, reliability, and validity of the daily telephone discipline interview. Behavioral Assessment, 13, 221–239.
Wechsler, D. (1991). Wechsler intelligence scale for children – third edition: Manual. San Antonio: The Psychological Corporation.
Weisz, J. R. (2004). Psychotherapy for children and adolescents: Evidence-based treatments and case examples. New York: Cambridge University Press.
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The authors would like to acknowledge Brandi Stupica, M.S. who provided statistical consultation.
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This research was supported by a grant from the National Institute of Mental Health (R03MH070666–1) to the first author.
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Chronis-Tuscano, A., O’Brien, K.A., Johnston, C. et al. The Relation Between Maternal ADHD Symptoms & Improvement in Child Behavior Following Brief Behavioral Parent Training is Mediated by Change in Negative Parenting. J Abnorm Child Psychol 39, 1047–1057 (2011). https://doi.org/10.1007/s10802-011-9518-2
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DOI: https://doi.org/10.1007/s10802-011-9518-2